Provider Demographics
NPI:1659491223
Name:PROFESSIONAL HEARING AID CENTER
Entity Type:Organization
Organization Name:PROFESSIONAL HEARING AID CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BCHIS
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:RANDOLPH
Authorized Official - Last Name:FLANAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-889-4327
Mailing Address - Street 1:1306 E SUNSHINE ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-1144
Mailing Address - Country:US
Mailing Address - Phone:417-889-4327
Mailing Address - Fax:417-889-3277
Practice Address - Street 1:1306 E SUNSHINE ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-1144
Practice Address - Country:US
Practice Address - Phone:417-889-4327
Practice Address - Fax:417-889-3277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO000622237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty